Anaesthesia for Congenital Hypertrophic Pyloric Stenosis. A Review of 350 Patients

MacDonald, Nicholas J.; Fitzpatrick, G.; Moore, Kathryn P.; Wren, W. S.; Keenan, M.

doi:10.1097/00132586-198802000-00039

Cited by 4 publications

(5 citation statements)

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“…In the postanaesthesia recovery period, the infant should be carefully observed for signs of respiratory depression and periods of apnoea secondary to effects of metabolic alkalosis, general anaesthesia, and decreased body temperature [10]. Anaesthesia related morbidity rate, once noted to be as high as 3.7%, is on the decline and recent studies have shown no complications after general anaesthesia [11,12]. There were no adverse anaesthetic events noted in our series.…”

Section: Discussionmentioning

confidence: 58%

Idiopathic Hypertrophie Pyloric Stenosis : Our Experience

Puri

Sreevastava

Kalra³

2006

Medical Journal Armed Forces India

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Background : A typical infant with idiopathic hypertrophic pyloric stenosis is described as a male child, first in the order of birth with a positive family history. However our experience suggests otherwise which is presented in this report. Methods : A retrospective analysis of medical records of 8 infants, who were diagnosed to be suffering from idiopathic hypertrophic pyloric stenosis and subjected to surgical treatment, was undertaken. Results : There were 5 (62.5%) males and 3 (37.5%) females. There was no family history and only one child (12.5%) was first born in the order of birth. One infant was preterm and one case (12.5%) had associated congenital anomaly (single kidney). Definitive diagnosis was established in 6 (75%) babies at admission whereas, other 2 cases (25%) required further evaluation. All the infants were in a state of moderate dehydration and in a varying state of hypochloremic alkalosis. The pH and serum chloride levels ranged from 7.52 to 7.67 and 86-94 mmol/L respectively. All were subjected to traditional Ramstedt's pyloromyotomy after having undergone vigorous correction of fluids and electrolytes for 24-48 hours. Intraoperatively, there was one iatrogenic mucosal perforation, which was closed with an omental patch. Postoperative feeding was initiated 12 hrs after surgery in 6 (75%) babies. Conclusion : Our series suggests a clinical profile of hypertrophic pyloric stenosis in our subset of patients which is different from what is described in literature. MJAFI 2006; 62 : 216-219

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Section: Discussionmentioning

confidence: 58%

Idiopathic Hypertrophie Pyloric Stenosis : Our Experience

Puri

Sreevastava

Kalra³

2006

Medical Journal Armed Forces India

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“…Anaesthesia for pyloric stenosis can be associated with critical events 17 and significant morbidity 18 . The risks of anaesthesia increase almost 10‐fold in patients under 1 year compared with older children 19 .…”

Section: Paediatric Anaesthesiamentioning

confidence: 99%

Determinants of good outcome in pyloric stenosis

Allan

2006

J Paediatrics Child Health

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Good outcome following pyloromyotomy for pyloric stenosis is dependent on the training of the surgeon, availability of a specialist paediatric anaesthetist, and the quality of preoperative correction of fluid and electrolyte abnormalities. Complications (including death, inadvertent duodenal perforation, incomplete pyloromyotomy, wound dehiscence and infection), higher hospital costs and increased length of hospital stay are all more likely to occur when the pyloromyotomy is performed by a surgeon who has had no speciailist paediatric surgical training.

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“…Given these concerns, some authors have suggested alternative RSI techniques while others have suggested that RSI has no place in the practice of pediatric anesthesia . A controlled RSI technique defined as bag‐valve‐mask ventilation with peak inflating pressure <10–12 cmH 2 O, avoidance of cricoid pressure, and the use of a nondepolarizing NMBA has been offered as an alternative technique for emergency endotracheal intubation in pediatric patients .…”

Section: Anesthetic Induction Techniquementioning

confidence: 99%

“…The authors concluded that, when compared with the classical RSI, there were fewer episodes of hypoxemia, no bradycardia, and improved conditions for endotracheal intubation with controlled RSI. Despite its continued widespread use in the practice of anesthesia, there is little to no evidence‐based medicine supporting the role of classic RSI in preventing gastric aspiration (see below) .…”

Section: Anesthetic Induction Techniquementioning

confidence: 99%

Perioperative care of infants with pyloric stenosis

Kamata

Cartabuke

Tobias

2015

Pediatric Anesthesia

124

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Pyloric stenosis (PS) is one of the most common surgical conditions affecting neonates and young infants. The definitive treatment for PS is surgical pyloromyotomy, either open or laparoscopic. However, surgical intervention should never be considered urgent or emergent. More importantly, emergent medical intervention may be required to correct intravascular volume depletion and electrolyte disturbances. Given advancements in surgical and perioperative care, morbidity and mortality from PS should be limited. However, either may occur related to poor preoperative resuscitation, anesthetic management difficulties, or postoperative complications. The following manuscript reviews the current evidence-based medicine regarding the perioperative care of infants with PS with focus on the preoperative assessment and correction of metabolic abnormalities, intraoperative care including airway management (particularly debate related to rapid sequence intubation), maintenance anesthetic techniques, and techniques for postoperative pain management. Additionally, reports of applications of regional anesthesia for either postoperative pain control or as an alternative to general anesthesia are discussed. Management recommendations are provided whenever possible.

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Anaesthesia for Congenital Hypertrophic Pyloric Stenosis. A Review of 350 Patients

Cited by 4 publications

References 0 publications

Idiopathic Hypertrophie Pyloric Stenosis : Our Experience

Idiopathic Hypertrophie Pyloric Stenosis : Our Experience

Determinants of good outcome in pyloric stenosis

Perioperative care of infants with pyloric stenosis

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